Sorafenib treatment in Child–Pugh A and B patients with advanced hepatocellular carcinoma: safety, efficacy and prognostic factors

Ogasawara, Satoshi; Chiba, Tadatoshi; Ooka, Yoshihiko; Kanogawa, Naoya; Motoyama, Tenyu; Suzuki, Eiichiro; Tawada, Akinobu; Kanai, Fumihiko; Yokosuka, Osamu

doi:10.1007/s10637-015-0237-3

Cited by 79 publications

(69 citation statements)

References 29 publications

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“…With regard to cases in whom a response was not obtained, once sorafenib was introduced as a secondary treatment, and a more favorable prognosis was obtained as compared to the nontreatment group. At the time of discontinuation due to tumor progression or adverse events, in approximately 90% of cases, the Child-Pugh score was maintained at ≤7 points, and it was thought that overall, sorafenib introduction secondary to LFP treatment was possible [15]. In the present study, for secondary treatments following LFP, regardless of the maintenance of hepatic functional reserve, BSC was often selected.…”

Section: Discussionmentioning

confidence: 95%

Sorafenib versus Hepatic Arterial Infusion Chemotherapy as Initial Treatment for Hepatocellular Carcinoma with Advanced Portal Vein Tumor Thrombosis

et al. 2017

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Objective: To investigate the validity of hepatic arterial infusion chemotherapy with low-dose 5-fluorouracil and cisplatin (LFP) versus sorafenib as first-line treatment for hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (Vp3, Vp4). Patients and Methods: We retrospectively reviewed the cases of Child-Pugh A advanced HCC with Vp3 or Vp4 treated with LFP or sorafenib between October 2002 and December 2013. Results: There were 32 patients in the LFP group and 14 patients in the sorafenib group. The objective response rate/disease control rate was 31.3/56.3% in the LFP group and 0/28.6% in the sorafenib group. The median survival time (MST) (309 vs. 120 days; p = 0.009) and the median time to treatment failure (109 vs. 37 days; p = 0.022) were significantly longer in the LFP group than in the sorafenib group. In the LFP group, a relatively favorable outcome (MST, 622 days) was obtained among the response cases. Among the nonresponse cases in the LFP group, at the time of cessation of LFP, 70.4% of cases were Child-Pugh A and 88.9% of cases maintained a score of ≤7 points; of the cases in whom Child-Pugh A was maintained, the survival period from the time of LFP discontinuation was significantly longer in the cases in whom sorafenib was introduced as a secondary treatment after LFP than in the cases treated with best supportive care (220 vs. 89 days; p = 0.002). The main adverse event with LFP was grade 3 or higher cytopenia, which was manageable, and adverse event-induced discontinuation was significantly lower as compared with sorafenib (p = 0.002). Conclusion: For the treatment of HCC with Vp3/Vp4, it is desirable to initially use LFP and then immediately change to sorafenib if no response is obtained.

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Section: Discussionmentioning

confidence: 95%

Sorafenib versus Hepatic Arterial Infusion Chemotherapy as Initial Treatment for Hepatocellular Carcinoma with Advanced Portal Vein Tumor Thrombosis

et al. 2017

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“…This might be due to the difference in background liver such as chronic liver disease or normal liver [4,5]. On the other hand, HCV eradication could improve the hepatic functional reserve even for patients with Child-Pugh grade A liver cirrhosis and may have a favorable influence on the clinical outcome of patients with advanced HCC treated with sorafenib [16] ; however, these effects remain unclear. Therefore, in this study, we examined the impact of HCV eradication on the clinical outcome of patients with HCV-related advanced HCC treated with sorafenib.…”

Section: Discussionmentioning

confidence: 99%

Impact of Hepatitis C Virus Eradication on the Clinical Outcome of Patients with Hepatitis C Virus-Related Advanced Hepatocellular Carcinoma Treated with Sorafenib

Kawaoka

Aikata²,

Teraoka³

et al. 2017

Oncology

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Objective: To evaluate the impact of hepatitis C virus (HCV) eradication on the clinical outcome of patients with HCV-related advanced hepatocellular carcinoma (HCC) treated with sorafenib. Methods: A total of 58 HCV-related advanced HCC patients with Child-Pugh grade A disease who were treated with sorafenib were enrolled in this retrospective cohort study. Of these, 27 patients were HCV RNA negative as a result of previous antiviral therapy (sustained viral response [SVR] group), while the remaining 31 were HCV RNA positive (non-SVR group). Results: The response rate, disease control rate and median time to progression in the SVR group (6, 46.0%, and 3.8 months, respectively) were similar to those in the non-SVR group (3, 51.5%, and 2.7 months, respectively). On the other hand, the median time to treatment failure (TTTF), post-progression survival (PPS), and overall survival (OS) were significantly longer in the SVR group than in the non-SVR group (9.7, 8.5, and 15 months vs. 5.9, 5.2, and 9.3 months; p = 0.023, 0.02, and 0.014, respectively). On multivariate analysis, SVR was identified as a significant and independent determinant of PPS (p = 0.009), TTTF (p = 0.028), and OS (p = 0.01). Conclusion: HCV eradication before sorafenib treatment for HCV-related advanced HCC could prolong PPS and TTTF and improve OS.

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“…Since the approval of sorafenib, studies have focused primarily on the safety and efficacy of this new molecular-targeted therapy in single-institution, clinical settings [5,13,14]. While these studies have each demonstrated clinical benefit in treating advanced HCC [5,13,14], others note the need to balance this opportunity with the potential for side effects and high treatment costs in the community setting [15,16].…”

Section: Introductionmentioning

confidence: 99%

“…While these studies have each demonstrated clinical benefit in treating advanced HCC [5,13,14], others note the need to balance this opportunity with the potential for side effects and high treatment costs in the community setting [15,16]. Specifically, treatment with sorafenib may cause a higher incidence of adverse drug reactions, such as hand-foot skin reactions, hypertension, and diarrhea, as well as an estimated USD 10,000-15,000/month in drug-related treatment costs [8,17,18,19,20].…”

Section: Introductionmentioning

confidence: 99%

Adoption of Sorafenib for the Treatment of Advanced-Stage Hepatocellular Carcinoma in Oncology Practices in the United States

et al. 2017

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Background: The adoption of sorafenib into oncology practice as a first-line systemic treatment for advanced hepatocellular carcinoma (HCC) is not well understood. We examined sorafenib use since Food and Drug Administration (FDA) approval in 2007 and associated survival for individuals diagnosed with advanced HCC, conducting a population-based evaluation of treatment patterns and outcomes for this newly approved drug in the US over time. Methods: We identified individuals diagnosed with Barcelona Clinic Liver Cancer Stage C from the 2007 and 2012 National Cancer Institute Patterns of Care study. We examined trends in use as well as patient and clinical factors associated with receiving sorafenib using multivariate logistic regression analysis. We then evaluated the association between sorafenib use and overall hazard of death using multivariate Cox proportional hazards regression. Results: Among 550 individuals diagnosed with advanced HCC, we found no significant increase in the proportion of patients treated with sorafenib from 2007 to 2012 (26.3 vs. 30.4%). After adjusting for patient and clinical characteristics, non-Hispanic Blacks (compared to non-Hispanic Whites) and those with a lower Child-Pugh score remained more likely to receive sorafenib. Individuals receiving systemic chemotherapy only, radiation therapy only, or no treatment at all experienced a higher risk of death than those treated with sorafenib, while those receiving a transplant experienced a lower risk of death. Conclusions: Sorafenib has not been widely adopted into oncology practice since FDA approval for advanced HCC. Few factors apart from Child-Pugh score and race/ethnicity predict sorafenib use in clinical practice, although sorafenib treatment is associated with a lower risk of death.

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Sorafenib treatment in Child–Pugh A and B patients with advanced hepatocellular carcinoma: safety, efficacy and prognostic factors

Cited by 79 publications

References 29 publications

Sorafenib versus Hepatic Arterial Infusion Chemotherapy as Initial Treatment for Hepatocellular Carcinoma with Advanced Portal Vein Tumor Thrombosis

Sorafenib versus Hepatic Arterial Infusion Chemotherapy as Initial Treatment for Hepatocellular Carcinoma with Advanced Portal Vein Tumor Thrombosis

Impact of Hepatitis C Virus Eradication on the Clinical Outcome of Patients with Hepatitis C Virus-Related Advanced Hepatocellular Carcinoma Treated with Sorafenib

Adoption of Sorafenib for the Treatment of Advanced-Stage Hepatocellular Carcinoma in Oncology Practices in the United States

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